Provider Demographics
NPI:1124364252
Name:BEAUMONT FAMILY DENTISTRY AT LEESTOWN
Entity type:Organization
Organization Name:BEAUMONT FAMILY DENTISTRY AT LEESTOWN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:TAKACS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:859-223-2120
Mailing Address - Street 1:100 TRADE ST
Mailing Address - Street 2:SUITE175
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-2634
Mailing Address - Country:US
Mailing Address - Phone:859-368-8206
Mailing Address - Fax:859-554-6150
Practice Address - Street 1:100 TRADE ST
Practice Address - Street 2:SUITE175
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40511-2634
Practice Address - Country:US
Practice Address - Phone:859-368-8206
Practice Address - Fax:859-554-6150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty